Category: Babys and Toddlers

Potty-training can be a challenge for parents, but it’s also an important part childhood development. The normal struggle can be even more difficult when there are sensory processing issues. Recognizing that they need to go, wearing big girl or big boy underwear, and being able to use different toilets can all be impacted by sensory processing.

Why does Sensory processing matter?

Toileting requires a significant amount of body awareness. Children have to understand how their body is feeling, learn how to release their bowel and bladder muscles in order to go, and feel that they have “finished” and their bowel or bladder is now empty.

Sensory processing is a natural part of the toileting process.

A bathroom environment can be overstimulating to start with. We receive sensory information from our eyes, ears, skin, muscles, and joints and our brain’s job is to organize the information, select the important parts, and disregard the rest. When a child’s sensory systems are functioning appropriately, they are able to participate in activities of daily living such as potty-training. However, if the sensory systems are not integrated properly, toileting can become problematic.

what is Sensory Processing?

Sensory Processing refers to how the nervous system detects, regulates, interprets and responds to sensory information. Sensory Processing is an important factor in considering a child’s attention, memory, behavior, and function (Ahn, Miller, Milberger, & McIntosh, 2004; Gardner &Johnson, 2013). A child’s brain needs to be able to register sensory information from the environment and react appropriately to it. If a child has difficulty regulating and processing sensory information, they may have Sensory Processing Disorder.

Sensory Processing Disorder is a neurological disorder in which the sensory information that a child perceives results in abnormal responses. Children who have difficulty processing sensory information often have inconsistent responses because they have a hard time discriminating between which sensory information is important and which can be ignored.

It is important to note that many children (and adults for that matter) have difficulty with processing certain types of sensory input. Typical things such as disliking certain smells or textures, feeling seasick on rides, or preferring certain foods do not necessarily mean that a child has sensory processing disorder. They may simply still be learning to process certain sensory stimuli.

There are eight sensory systems in our bodies:

Tactile System (touch)

Vestibular System (balance)

Proprioceptive System (position in space)

Olfactory System (smell)

Visual System (sight)

Auditory System (hearing)

Gustatory System (taste)

Interoceptive System (internal body awareness)

Interoception is our ability to sense what is going on inside our bodies internally. It includes sensations such as thirst, hunger, fatigue, pain, breath, itchiness, nausea, temperature, etc. It also includes our sense of if we have a full bladder or bowel, and if we have “released” it. (Garland, 2014).

An Explanation of the Sensory Systems related to Toileting

The proprioceptive, vestibular, and touch senses are primary influences on the integration of our senses. The interoceptive sense also plays a crucial role in developing the foundational body awareness needed to function as a child.

When a child is unable to integrate and react to sensory information appropriately, the child will not interact with his environment in a functional manner. He may have exaggerated responses to typical noises or sensations or withdraw from certain stimuli. The child cannot consistently process sensory information, so their responses will be inconsistent, too.

If the child has decreased body awareness, they may demonstrate an inefficient grading of force or movement. For a boy, this may mean they have difficulty using the right amount of force when holding or aiming the penis. This might result in a child pressing so hard that it’s difficult to pee, holding too tightly, or having difficulty holding steady.

Our vestibular system helps us to maintain our balance. The fluid in our inner ear moves as our head moves, sending messages to our brain about where our body is in space (Abraham, 2002). Some children with vestibular dysfunction present with “gravitational insecurity“, which makes them seek a secure position during activities. They may dislike swings, being picked up, or participating in activities in which they are not in control of their body in space. These children might be fearful when attempting to sit on a “grown-up” toilet where their bottom is unsupported because they feel like they may fall.

Children with vestibular, tactile, and proprioception difficulties may have difficulty with eye-hand coordination and depth perception. It may be difficult for them to aim appropriately or estimate where to stand.

Many children with sensory processing difficulties have auditory sensitivities that interfere with toilet training. Think of the loud echoes, flushing toilet, the hand dryers, etc. Noises that are simply loud to an adult can be piercing to a child with auditory sensitivities.

Tactile sensitivities can interfere with toileting, too! Children may dislike the sensation of pooping, wiping, or even sitting on a hard seat. If they are under-responsive to touch, they may not realize that they aren’t covering their hand properly with the toilet paper, they aren’t wiping well enough to clean themselves, or that they’ve soiled their clothing.

Sensory Processing and Body Awareness needed for Toilet Training

When our body is able to receive and interpret the signals from our skin, muscles, and joints, we are able to feel and know what our body is doing without looking at it. When a child has poor body awareness, it can lead to difficulty coordinating their body to do all of the components that are involved in toileting. It is not automatic to feel the urge to go and just go to the bathroom. Each step of the task must be thought out and carefully performed, so it is important to be patient. It’s hard to know what to do if you can’t feel what you are supposed to feel!

Typically, toddlers and preschoolers spend a lot of time learning the “ins and outs” of toileting. Children are expected to be toileting independently before entering Kindergarten. Children with difficulties modulating sensory input find potty training to be a much bigger challenge than a typical child. The bathroom can be an overstimulating environment, so asking a child with sensory integration difficulties to focus on the task at hand (ie; peeing or pooping) is a challenge if they are overwhelmed with fear or anxiety about other sensory signals they are receiving. Problems with toileting and sensory processing might include (but not be limited to) the following:

Toileting and Sensory Processing Problems

1. Toileting and Sensory Processing Related to Poor Interoception

May be unaware that his bowel or bladder is full.

Feels that they need to go, but not be able to discriminate whether they need to urinate OR have a bowel movement.

Unable to “push” in order to go; don’t understand how to make those muscles work

Cannot feel that they have had an accident or that their clothes are soiled.

Unable to bend and reach behind them to properly wipe

2. Toileting and Sensory Processing Related to Sensory Defensiveness

Dislikes the feeling of “peeing” or “pooping” and withholds.

Fearful of falling into a regular sized toilet

Dislikes the feeling of wiping or being wiped.

Prefers the parent to wipe them

Does not like to wash their hands

Takes off all their clothes to use a toilet

Avoids flushing the toilet

3. Toileting and Sensory Processing Issues Related to Poor Registration of Sensory Input with a Hyperactive or Over-reactive Response

The child is fearful of the sensations involved when they pee or poop.

Reports that the act of “peeing” or “pooing” hurts terribly, crying, etc.

Extreme reaction to the sound of the flush or the air dryer

Gags, or chokes at the smell of the poop

Visually distracted by details in the bathroom, including lines in the tile, dust on the floor, etc.

Will tell you when the diaper needs to be changed, doesn’t want a wet diaper

Difficulty tolerating new bathrooms, public bathrooms, etc.

Covers ears when flushing, air hand dryer goes on, etc.

Holds nose for bowel movements

Avoids using certain toilets with “hard” seats

Avoids going into the bathroom, “sneaks off” to poop in diaper behind a couch, etc.

How to Help: 15 Amazing Strategies for Toileting

1. Try a 4 in 1 Stages Potty Seat which is closer to the ground and fits a smaller bottom. It also helps transition to use a grown-up toilet

2. Try fun potty seats like this Race Car Potty and Character Underwear that are motivating!

3. Try using flushable wipes and a Wipes Warmer to make the experience of wiping more enjoyable

* one consideration for this is that your child may begin to rely on it…. if you are out in public and don’t have warm wipes, will it be a problem? Take that into consideration before making it part of your routine. But if you are desperate, it’s worth a shot!

4. Sing Songs to make toilet training more fun:

“Let it go! Let it go!”

“Push it out, Push it out, WAY OUT!”

“Pee Pee in the Potty, Pee Pee in the Potty!”

“I just want to Potty all the time, Potty all the time, Potty all the time!”

5. Use painter’s tape to make a line for boys to know where to stand

6. Offer Toilet Targets or use goldfish crackers or fruit loops (get the pee in the hole!)

7. For children who aren’t sure if they have to pee OR poop, let them sit. It’s hard to tell which muscles are which.

13. Try a toileting schedule. Have your child sit on the toilet every 15 minutes for a few minutes. If they go, Wahoo! big Praise. If not, that’s ok, we’ll try again in 15 minutes.

14. Provide a Kitchen Timer for set “potty” sitting times. Let your child set the timer so they are a part of the process.

15. If your child is fearful of the sensation of pooping in the toilet, have them help you dump the poop from the diaper into the toilet and then flush it.

Toileting and Sensory Processing in Children with Special Needs

Very often problems with potty-training, such as accidents, difficulty recognizing if they have to go, struggles with hygiene, fear of flushing, and refusal to use the toilet are the result of an inefficient sensory processing system. It is important to note that children with developmental delays and other diagnoses may need more time to be trained. As parents and educators, it is essential to treat the process with patience. Your child has a lot of information and sensory signals to make sense of and every child has to go at their own pace. Do not feel the “peer pressure” from other parents that your child “should be” ready.

Functional Skills for Kids

This post is part of the Functional Skills for Kids series. See all of the bloggers who are participating and more about the series here. For more information on the components and considerations related to Toileting, stop by and see what the other Occupational Therapists and Physical Therapists on the Functional Skills for Kids team have to say:

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Finding the perfect high chair can be a daunting task for a new mom. Baby feeding specialist Rachel Coley guest posts on how to choose the best high chair for your baby

TIPS TO CHOOSE THE BEST HIGH CHAIR FOR BABY

If you’ve ever spent an hour pouring over Amazon product reviews desperate for a clear-cut, final, definitive, let-me-get-off-the-computer-and-go-to-bed answer to which swaddle, stroller, pacifier, baby carrier or car seat is the best for your little one, I need to warn you ahead of time that I won’t be sharing the #1 best high chair brand and model for your baby today.

Truth is – I can’t. I don’t know your home’s space constraints, if you have a preference for a wooden chair or a plastic chair, if you care about how cute your baby gear is, etc.

BUT, as a pediatric Occupational Therapist and feeding therapist what I can share with you is the #1 most important thing to consider when you choose the best high chair for your baby and your family:

Baby shower gifts can be so dull and boring. Finally, a different personal baby shower gift that the new mom definitely didn’t register for, The Best Baby Shower Gift Ever

I have a confession: I hate baby showers.

And bridal showers too.

I know it makes me a horrible person. And I am TRULY happy for my friend and their new milestone. I just hate having to sit somewhere for four hours drinking punch with no liquor in it when I could be reading a book, going to yoga or cleaning out my closet.

I’m a terrible person. I know.

BUT – I suck it up and do my womanly duty because it’s the right thing to do and I know my friend needs the loot.

Plus, I LOVE to give presents. I always give my BEST EVER “Miss Jaime OT” baby shower gift. I’ve perfected it over the years and every one of my friends has gushed about how useful it was. Plus, NO ONE thinks to register for it.

I can’t wait to share it with you!

Every new mom registers for diapers, bottles, and sheets, etc. They go up and down the aisles aiming their “gift gun” at all kinds of silly things that they may never end up using; noise machines, diaper genies, and special “baby” detergent.

Preschool Special Education Services…What does it all mean?

If your child is between the ages of three and five years old and you suspect they may have a delay or a disability, you should contact your school district’s Committee on Preschool Education Department (CPSE). You can almost always access the contact information on your district’s website. Smaller districts may combine the preschool and school-age offices into one big Special Education department. Either way, if you call the Special Education number and tell them you need to speak to someone about your preschool age child, they will direct you to the proper person.

Early Intervention services are different than preschool services. For information about getting your child under three years old evaluated, click here.

So then what happens?

If you suspect a delay and wish to have your child evaluated, you need to make a referral to your district CPSE. A referral can be made by a parent, a teacher or a professional in your child’s school, doctors, judicial officers (such as a family court judge or a probation officer) or a designated person in a public agency. In addition, a referral may also be made by someone from an Early Childhood Direction Center, an approved preschool program or an Early Intervention Program that serves children with disabilities from birth to age three.

A referral is a written statement directed to your school district asking that your child is evaluated to determine if he or she qualifies for special education services. You should submit the letter to the CPSE chairperson or Special Education Director. When you write your referral, it is a great idea to include some details about why you are requesting the evaluation. This will help the committee to make sure they are assessing your child appropriately in the areas that you are concerned about. Also, include your child’s name and date of birth.

The evaluation process will include various assessments from educational professionals. Each child is tested according to the Committee’s concerns. For example, if a parent or teacher voices concerns over the child’s language skills, a speech and language evaluation may be included as part of the child’s evaluation process. Another child may have strong language skills but very poor motor skills, so that child would be evaluated for occupational or physical therapy, but not speech and language.

As I mentioned before; give some details about why you are concerned.

“My son Johnny has a lot of difficulty running without falling down, he struggles to sit up straight, he appears clumsy and bumps into furniture, etc.”

“Annie still has a very limited vocabulary and is difficult to understand when she is talking. My husband and I can understand her, but strangers don’t know what she is saying.”

“Jayden still switches hands when he picks up his scissors or a crayon. He dislikes wearing socks and tantrums if we insist that he uses a spoon instead of his fingers.”

“Matthew’s teacher states that he only likes to play by himself. He needs constant reminders not to shout indoors. He has been getting aggressive with his friends, and he hit someone last week when he was upset”

This will help the committee to make sure they are assessing your child appropriately in the areas that you are concerned about. After all, you know your child better than we do!

***Miss Jaime OT’s #1 tip – as you begin this process, get in the habit of being very organized. Get a binder or a file folder and keep all of your child’s evaluations, IEP’s and paperwork in one spot. You won’t regret it!

Next, you will receive a request for your written consent to have your child evaluated. Make sure you return the papers! I can’t tell you how many times a parent has complained about the evaluation taking too long when it is simply because the district doesn’t have written consent. It may seem redundant, but legally the district has to have their “ducks in a row” before they can get started.

The evaluations can take place at your child’s preschool or your home. Your district will provide you with a list of evaluators or agencies that you can choose from. I suggest asking your friends for input- did they use an agency that they really like? If you don’t know anyone whose child has been evaluated, you can ask your CPSE chair for suggestions.

The evaluations will take place at no cost to you.

The evaluations must be comprehensive and will be conducted by a psychologist and other professionals that have specific knowledge about your child’s disability (special education teacher, speech therapist, occupational therapist, etc.) It will probably take a few sessions to get all of the testing done. In addition, you will be contacted for information regarding your child’s milestones, habits, strengths, weaknesses, etc. This is called a social history.

The results of the evaluations will be shared with you face to face or by mail. You will then have a formal CPSE meeting where all of the professionals who worked with your child will go over the results of their testing. You can bring any additional information or testing to this meeting to add to your child’s case. The point of this meeting is to get a complete “picture” of your child and to determine if they meet the criteria to qualify for Special Education services. If you have questions about any of the reports prior to the meeting, feel free to call that evaluator or the CPSE chairperson. It is only fair that you understand what you are reading. Sometimes the educational reports get very wordy and confusing for someone who isn’t in the field. It’s Ok, just ask!

In order to be eligible to receive services, your child must meet the criteria set forth by the New York State Education Department. It must be determined that your child has a disability which impacts his ability to learn. Here are the NY state regulations on determining if a preschooler meets criteria to receive special education services.

So all the testing is done… Now what?

If the CPSE determines that your child is ineligible for Special Education services, they will explain to you why your child doesn’t qualify and provide you with written notice of this decision. If you disagree with the recommendations or decisions of the CPSE, you can begin steps to request mediation or an impartial hearing. Click on the link above for more information regarding mediation. You can also consider going through your health insurance. You would need to speak to your family physician as well as your insurance company to see if these services are covered. A final option would be to pay privately for the services you feel your child needs. Much like a tutor, a private teacher or therapist would work on your areas of concern at a schedule that is convenient for you.

If the CPSE determines that your child is eligible for Special Education services, the Committee will then take the steps to develop an IEP for your child. An IEP is an individualized education plan that is developed specifically for your child’s educational needs. The Committee can consider providing your child with just related services (speech and language or OT) or counseling. Sometimes a child needs a SEIT Special Education Itinerant Teacher or even a half day program. Each IEP is designed to address your child’s strengths and weaknesses in the Least Restrictive Environment. The Committee will discuss the supports, services, and modifications to meet your child’s needs.

Once the IEP is developed, you will receive a written copy which will include the goals that the professionals servicing your child are working toward. The district will follow a timeline to set up the services for your child in a timely manner so that he or she can begin getting the help they need as soon as possible.

Here is the link to the New York State Special Education Website, which includes more detailed specific information about the process.

The process takes a while to learn, but soon you will be an expert! Consider joining your district’s SEPTA (Special Education Parent Teacher Association) to learn more about the Special Education process and all the supports that are available to you and your child.

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You noticed that your baby isn’t able to do some of the things that other children his age can do.

What do you do now?

Who do you call?

Where do you go?

*This post contains affiliate links

There are a lot of feelings and worries attached to getting services for your child. BUT the importance of getting your child the services they need can not be stressed enough!

Here are some tips to help you get started.

The whole process can be overwhelming; but the sooner you get started, the better. If a child is behind in development and he isn’t getting help, the gap will only get wider.

EARLY INTERVENTION- services for children birth to three years old

Children who are younger than three years old who qualify for services will receive them through the County Department Of Health. The first thing you should do is contact your county DOH. Here is the information for Long Island, New York.

NASSAU COUNTY

Look for the early intervention or special education services number on your city or county’s department of health web page. The process will be the same.

What will happen next?

The County Department of Health will set you up with a “service coordinator”, who will be your “go-to” person in regards to getting your children’s evaluations set up and services delivered.

If your child has a diagnosed with a disability, she or he will always be eligible for early intervention services. Some children do not have a diagnosis but exhibit delays that cause their parents concern. Your Service Coordinator will set up a multidisciplinary evaluation to look at all areas of development and help with the development of an Individualized Family Service Plan (IFSP).

Every child referred to the Early Intervention Program has the right to a free multidisciplinary evaluation. This is sometimes referred to as a “core evaluation”. Multidisciplinary simply means that more than one professional will be a part of your child’s evaluation. Your child’s evaluation team should have:

A professional who can look at your child’s overall development.

A professional with special knowledge about your child’s problem. For example, if your child is delayed in sitting up or other motor abilities, an occupational therapist might be on your child’s team.

Your initial service coordinator will give you a list of evaluators. You have the right to choose any evaluator from this list. You can ask your initial service coordinator if you need more information about an evaluator to help you decide what will be best for your child and family. You can also ask your friends or family if they have used a particular agency or evaluator that they were happy with. Once you pick an evaluator, either you or the initial service coordinator – with your permission – will call the evaluator and make an appointment for your child and family.

Here’s what happens next:

The evaluators will usually come to your house for the evaluation. It takes between an hour and an hour and a half. They will play with your child, look for particular skills within their field, and ask you a lot of questions about your child, their milestones, etc.

The evaluators will contact you (usually within a week or two) to tell you what they found, what they think your child’s strengths and weaknesses are, and if they qualify for services.

Once it is deemed that your child qualifies for services, your Service Coordinator will help you to set up therapy and/or services for your child.

The team will then develop an IFSP (Individualized Family Service Plan) which will outline your child’s strengths and weaknesses. It will also state the goals that your child’s therapists will be working toward, and what methods they will use to achieve these goals. Your family will have input into the IFSP.

For more information about IFSP’s, go to www.health.ny.gov/publications/0532/steps4-1.htm

The information was obtained from NYSED, and Suffolk and Nassau County department of health websites. For more information, check out the links provided.

Getting Early Intervention Services can be overwhelming to start this process but you are not alone! Good Luck!